Lovastatin

Brand names

• Apo-Lovastatin
• Gen-Lovastatin
• Mevacor

Usage

To treat high cholesterol. Usually prescribed after first lines of treatment-including diet, weight loss, and exercise-fail to reduce total and low-density lipoprotein (LDL) cholesterol to acceptable levels.

How it works

Lovastatin blocks the action of an enzyme required for the manufacture of cholesterol, thereby interfering with its formation. By lowering the amount of cholesterol in the liver cells, lovastatin increases the formation of receptors for LDL, and thereby reduces blood levels of total and LDL cholesterol. In addition to lowering LDL cholesterol, lovastatin also modestly reduces triglyceride levels and raises HDL (the so-called good) cholesterol.

Side effects

Serious

Fever, unusual or unexplained muscle aches and tenderness. Call your doctor right away.

Common

Side effects occur in only 1 % to 2% of patients. These include constipation or diarrhea, dizziness or lightheadedness, bloating or gas, heartburn, nausea, skin rash, stomach pain, rise in liver enzymes.

Less common

Sleeping difficulty.

Possible interactions

Other medicaments:

Lovastatin taken concurrently with:

• clofibrate (Atromid-S, others) may damage muscles (rhabdomyolysis).
• cyclosporine (Sandimmune) can cause a severe myopathy.
• diltiazem (Cardizem) may increase risk of myopathy.
• erythromycin (E.E.S.) and perhaps other macrolide antibiotics (clarithromycin or dirithromycin) may result in severe rhabdomyolysis.
• fluconazole (Diflucan), itraconazole (Sporanox) or ketoconazole (Nizoral) may increase risk of muscle damage (rhabdomyolysis).
• gemfibrozil (Lopid) may cause myopathy.
• levothyroxine (various) may decrease thyroxine benefits.
• nefazodone (Serzone) may lead to myopathy.
• niacin (various) can increase risk of muscle damage (myopathy). Niacin may also increase homocysteine levels-a risk factor for heart disease.
• quinupristin/dalfopristin (Synercid) may increase risk of muscle damage (rhabdomyolysis).
• ritonavir (Norvir), amprenavir (Agenerase) and perhaps other protease inhibitors may lead to Iovastatin toxicity.
• warfarin (Coumadin, others) may result in bleeding; increased frequency of INR (prothrombin time or protime) testing is suggested.

Foods:

Follow a standard low-cholesterol diet.

Herbal medicines or minerals:

Garlic may inhibit blood-clotting (platelet) aggregation-something to consider if you are already taking a platelet inhibitor. The FDA has allowed one dietary supplement called Cholestin to continue to be sold. This preparation actually contains lovastatin. Since use of two HMG-CoA inhibitors may increase risk of rhabdomyolysis or myopathy, the combination is not advised.
Use of plant stanol ester-containing products (Benecol) can help lower total and LDL cholesterol. Soy (milk, tofu, etc.) contains phytoestrogens that have led to an FDA-approved health claim for reducing risk of heart disease (if there are at least 6.25 grams of soy protein per serving). Substituting soy for some of the meat in your diet can also help results in fighting excessive cholesterol. Because lovastatin can deplete coenzyme Q10, supplementation may be needed.

Beverages:

Grapefruit juice can increase blood levels.

Discontinuation:

Do not stop this medicament without your physician's knowledge and guidance.

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